Background: Solid organ transplant recipients are at an increased risk of developing various malignancies due to long-term immunosuppressive therapy. Non-melanoma skin cancers (NMSC( are the most common malignancies in this population, half of which occur in the head and neck region. In the current study we assess the incidence and clinical features of non-melanoma skin cancer of the head and neck in solid organ recipients, and investigate their outcome and survival.

Methods: A retrospective chart review of the Rabin Medical Center cancer registry was conducted for solid organ transplant recipients (kidney, liver, lung, heart), who were treated at our institution from 1992 to 2015.

Results: Of 3,339 solid organ recipients, 259 patients developed a total of 697 head and neck NMSC. M: F ratio was 4: 1 with a mean age at diagnosis of 60 years (range 23-86). The mean follow-up period was 6 years. Squamous cell carcinoma (SCC) was the most common malignancy (55%), followed by basal cell carcinoma (44%). Other malignancies (1%) included Kaposi’s sarcoma, sebaceous carcinoma and sweat gland tumors. At the end of the follow-up period 17 patients (7%) died of malignant disease. The overall survival rate was 68% at 5 years, and 45% at 10 years. Kidney transplanted patients had better survival outcome compared to other organs recipients (median 10 vs. 7 years). Advanced stage cancers (stages III-IV; 4%) and aggressive patterns of tumors (8%) were related to increased overall and disease-specific mortality (p-values < .05). Treatment with Azathioprine and Tacrolimus was associated with worse prognosis (p-values < .05).

Conclusions: Solid organ transplant and immunosuppressive therapy increase the risk of developing NMSC. The high rate of aggressive pattern and advanced stage tumors leads to decreased survival.